The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers.

Background Informal caregiving is an integral part of the care of people with severe mental illness, but the support needs of those providing such care are not often met. Aims To determine whether interventions provided to people caring for those with severe mental illness improve the experience of caring and reduce caregiver burden. Method We conducted a systematic review and meta-analyses of randomised controlled trials (RCTs) of interventions delivered by health and social care services to informal carers (i.e. family or friends who provide support to someone with severe mental illness). Results Twenty-one RCTs with 1589 carers were included in the review. There was evidence suggesting that the carers’ experience of care was improved at the end of the intervention by psychoeducation (standardised mean difference –1.03, 95% CI –1.69 to –0.36) and support groups (SMD = –1.16, 95% CI –1.96 to –0.36). Psychoeducation had a benefit on psychological distress more than 6 months later (SMD = –1.79, 95% CI –3.01 to –0.56) but not immediately post-intervention. Support interventions had a beneficial effect on psychological distress at the end of the intervention (SMD = –0.99, 95% CI –1.48 to –0.49) as did problem-solving bibliotherapy (SMD = –1.57, 95% CI –1.79 to –1.35); these effects were maintained at follow-up. The quality of the evidence was mainly low and very low. Evidence for combining these interventions and for self-help and self-management was inconclusive. Conclusions Carer-focused interventions appear to improve the experience of caring and quality of life and reduce psychological distress of those caring for people with severe mental illness, and these benefits may be gained in first-episode psychosis. Interventions for carers should be considered as part of integrated services for people with severe mental health problems.

/pdf/interventions-to-improve-the-experience-of-caring-for-people-8kq0cg9kvi.pdf

Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis.

Psychosocial interventions in bipolar disorder: What, for whom, and when

Background Psychological interventions may be beneficial for bipolar disorder.
Aims Efficacy evaluation of psychological interventions for adults with bipolar disorder.
Methods A systematic review of randomised controlled trials.. Outcomes were meta-analysed using RevMan and confidence assessed using the GRADE-method.
Results We included 55 trials with 6010 participants. Moderate quality evidence associated individual psychological interventions with reduced relapses at post-treatment and follow-up, and collaborative care with a reduction in hospitalisations. . Low quality evidence associated group interventions with fewer depression relapses at post-treatment and follow-up, and family psycho-education with reduced symptoms of depression and mania at post-treatment.
Conclusions There is evidence that psychological interventions are effective for people with bipolar disorder. Limits were the very low quality of much of the evidence and therefore inconclusive. Further research should identify the most (cost)-effective interventions for each phase of this disorder.

/pdf/psychological-interventions-for-adults-with-bipolar-disorder-clil7kp6ru.pdf

Psychological interventions for adults with bipolar disorder: systematic review and meta-analysis

BackgroundFew trials have compared psychosocial therapies for people with bipolar affective disorder, and conventional meta-analyses provided limited comparisons between therapies.AimsTo combine evidence for the efficacy of psychosocial interventions used as adjunctive treatment of bipolar disorder in adults, using network meta-analysis (NMA).MethodSystematic review identified studies and NMA was used to pool data on relapse to mania or depression, medication adherence, and symptom scales for mania, depression and Global Assessment of Functioning (GAF).ResultsCarer-focused interventions significantly reduced the risk of depressive or manic relapse. Psychoeducation alone and in combination with cognitive-behavioural therapy (CBT) significantly reduced medication non-adherence. Psychoeducation plus CBT significantly reduced manic symptoms and increased GAF. No intervention was associated with a significant reduction in depression symptom scale scores.ConclusionsOnly interventions for family members affected relapse rates. Psychoeducation plus CBT reduced medication non-adherence, improved mania symptoms and GAF. Novel methods for addressing depressive symptoms are required.

/pdf/psychosocial-therapies-for-the-adjunctive-treatment-of-5bj9dlo8bv.pdf

Psychosocial therapies for the adjunctive treatment of bipolar disorder in adults: network meta-analysis

A randomised controlled trial of carer-focussed multi-family group psychoeducation in bipolar disorder.

Caregiver psychoeducation for first-episode psychosis

Abstract In a RCT of family psychoeducation, 47 carers of 34 patients were allocated to one of three groups; Multifamily Group Psychoeducation, Solution Focussed Group Therapy or Treatment as Usual. Carers in both the MFGP intervention and the SFGP arm demonstrated greater knowledge and reduction in burden than those in the TAU arm.

Iconographies supplémentaires de l'article : A randomised controlled trial of carer-focussed multi-family group psychoeducation in bipolar disorder

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A randomised controlled trial of carer-focussed multi-family group psychoeducation in bipolar disorder.

Caregiver psychoeducation for first-episode psychosis

Iconographies supplémentaires de l'article : A randomised controlled trial of carer-focussed multi-family group psychoeducation in bipolar disorder